Ethics & Public Policy Center

4 Rules for Replacing Obamacare

Republicans are in a strong position as the midterm election approaches. They are nearly certain to retain control of the House of Representatives in the next Congress and may pick up a few seats to add to their majority. They are also poised to make gains in the Senate, perhaps even adding the six seats necessary to take control of the upper chamber—and maybe more.

The mere possibility of full Republican control of Congress in 2015 is leading some to wonder what Republicans would do if they found themselves in such a position come January.

There is little doubt that doing something about Obamacare would be at the top of the list, and should be. The Republican candidates challenging incumbent Democratic senators are, to a person, running hard against the law. The Affordable Care Act remains extremely unpopular with voters for a whole host of reasons. It has raised premiums for millions of people, forced millions more out of their insurance plans and away from the doctors that they liked and were told they could keep, and is cutting Medicare and raising taxes to pay for a massive new entitlement program.

If a sizeable number of anti-Obamacare candidates win, they will rightfully believe they have a mandate from their voters to take some action. But it will not be easy. Whatever the outcome this November, there will be enough Democrats in the Senate to filibuster legislation or to sustain a presidential veto.

One type of budget legislation (“reconciliation”) can circumvent Senate filibusters, so, in theory, it would be possible to change the budgetary aspects of Obamacare with a simple majority vote. This would be fitting, given how Democrats used the procedure after Scott Brown reduced their majority from 60 to 59 Senators in 2010—and it could allow Congress to eliminate many of the most unsound aspects of Obamacare and then send it to President Obama for a certain veto.

Just getting the legislation to the president would require incredible discipline and a unified party to pull it off. A reconciliation bill is not in order until both the House and Senate pass a budget plan calling for such legislation. It could take six months or more for Congress to come to an agreement on a plan that presumably would reach fiscal balance at some point over the coming decade.

Moreover, any effort to repeal Obamacare would require Republicans to also pass a replacement plan to take the law’s place. The pre-Obamacare status quo is not the solution, as there were deep and systemic problems in the health system before 2010. Moreover, without a replacement plan, Republicans would be accused of harming millions who have, or would soon get, insurance under Obamacare. But a unified replacement plan is unlikely to appear anytime soon. Various Republican factions have deep disagreements about how to proceed with serious reform. More than likely, these differences will only get resolved when the Republican presidential nominee defines the party’s position in the 2016 campaign.

So a Republican-controlled Congress would bring new opportunities to roll back Obamacare, but there would be risks too. It must proceed carefully. Here are a few suggestions:

Keep your eyes on 2016. A Republican Congress cannot repeal Obamacare while President Obama is in office. Full repeal and replacement, in whatever form that eventually takes, can only happen if a Republican wins the White House in 2016 too. Republicans should therefore ask themselves before every decision: “Will this help or hurt our nominee in 2016?”

Pick your targets carefully. Although full repeal is not possible before 2017, some big changes could still happen. For starters, Republicans could move to protect anyone who wanted to stay in the insurance plan they had before Obamacare’s rules turned everything upside down. They could also limit subsidies for insurers participating in the Obamacare exchanges and eliminate the tax people must pay for going uninsured, which is among the law’s most unpopular provisions. And there is already proven bipartisan support for repeal of the employer mandate, which threatens to stall job creation during what can best be described as a tepid economic recovery. Finally, Republicans could target for repeal the Independent Payment Advisory Board — the unelected 15-member panel charged with enforcing new costs caps in Medicare. Some Democrats would support that effort too.

The Obama administration will oppose all of these changes, but some might be secured anyway because of Democratic defections. And, if picked carefully, the targets that aren’t enacted into law would help Republicans now — and during the 2016 campaign — by surfacing important differences with Democrats on health care.

Use reconciliation strategically. Although pursuing full repeal through reconciliation would not work, the maneuver could still be used to advance pieces of a repeal-and-replace strategy. The key is to find changes that can divide the coalition in support of Obamacare and thus put pressure on the president to sign the legislation. The provisions should also lay the foundation for broader changes in 2017. For instance, Republicans could provide states greater flexibility and new ways to broaden insurance to the poor without reliance on Medicaid. That would then serve as a key component of a full replacement plan when a new president is in office.

Be realistic about replace. Returning to the pre-Obamacare status quo will not appeal to most voters because the problems were rampant. A Republican plan to replace Obamacare needs to provide secure insurance for the sick and put affordable coverage within the financial reach of all Americans. And it should not disrupt the employer coverage that most middle-income families have and like. These principles can form the basis of a practical strategy to replace Obamacare, and Republicans would be wise to rally around them to set the stage for the next presidential administration, rather than engaging in a protracted debate over the perfect reform plan.

Republicans are poised to do well in 2014, in large part because of the backlash against the Affordable Care Act. Over the next two years, the party must capitalize on the opportunity and take steps to roll back the law, while setting the stage for bigger changes should a Republican take the presidential oath of office in 2017.

James C. Capretta is a senior fellow at the Ethics and Public Policy Center and a visiting fellow at the American Enterprise Institute.

Lanhee J. Chen is the David and Diane Steffy research fellow at the Hoover Institution. He served as policy director on the Romney-Ryan presidential campaign.